N.H. Azrin

Habit-reversal: A method of eliminating nervous habits and tics ☆

Abstract No clinical treatment for nervous habits has been generally effective. The present rationale is that nervous habits persist because of response chaining, limited awareness, excessive practice and social tolerance. A new procedure was devised for counteracting these influences: the client practiced movements which were the reverse of the nervous habit, he learned to be aware of each instance of the habit and to differentiate it from its usual response chain and he was given social approval for his efforts to inhibit the habit. The treatment was given during a single session to 12 clients who had diverse nervous habits such as nail-biting, thumb-sucking, eyelash-picking, head-jerking, shoulder-jerking, tongue-pushing and lisping. The habits were virtually eliminated on the very first day for all 12 clients and did not return during the extended follow-up for the 11 clients who followed the instructions.

A community-reinforcement approach to alcoholism.

Abstract Several theoretical approaches to alcoholism exist. An operant reinforcement approach was used in the present study to develop a new procedure that rearranged community reinforcers such as the job, family and social relations of the alcoholic such that drinking produced a time-out from a high density of reinforcement. The results showed that the alcoholics who received this Community-Reinforcement counseling drank less, worked more, spent more time with their families and out of institutions than did a matched control group of alcoholics who did not receive these procedures. This new approach appears to be an effective method of reducing alcoholism. An analysis in reinforcement terms is presented of the etiology, epidemiology, and treatment of alcoholism.

Reciprocity counseling: A rapid learning-based procedure for marital counseling

Abstract Existing marital counseling procedures have not been experimentally evaluated or generally have not been based on an experimentally derived theory. The present study formulated a model of marital discord based on reinforcement theory, developed a marital counseling procedure based on that theory and experimentally evaluated its effectiveness. The model viewed marital discord as the resultant of non-reciprocated reinforcement. The counseling procedures attempted to establish general marital reciprocity of reinforcement by teaching reciprocity in several specific areas of marital unhappiness. The reciprocity procedure was conducted for about 3–4 weeks with 12 couples, after first conducting a catharsis-type counseling as a control procedure. The results showed that the reciprocity procedure increased reported marital happiness, whereas the control procedure did not. Once reciprocity was achieved in a specific problem area, the benefits generalized somewhat to other yet-to-be counseled areas. The increase in marital happiness occurred for each of the specific areas of marital interaction, for 96 per cent of the clients, and was maintained and increased during the available follow-up period. These results indicate that the procedure is an effective, rapid and enduring method of producing marital happiness.

Restitution: a method of eliminating aggressive-disruptive behavior of retarded and brain damaged patients.

Abstract Current methods of penalizing aggressive and disruptive behaviors have elements of retribution that discourage general usage. A procedure was developed that provided disruptive offenders with re-education, removal of the reinforcement for the offense, time-out from general positive reinforcement, and an effort requirement. The offender was required by instructions or physical guidance to overcorrect the general psychological and physical disturbance created by the offense. The procedure was applied to one brain-damaged and two retarded patients, who displayed one or more of the following types of behavior: physical assault, property destruction, tantrums, continuous screaming, and biting, all of which had resisted other treatments such as time-out, punishment and social disapproval. The procedure reduced the disturbed behaviors of all patients to a near-zero level within one or two weeks and maintained this therapeutic effect with minimal staff attention. This method appears to be a rapid and effective treatment procedure for disruptive behavior and emphasizes the individuals responsibility for his actions.

Treatment of hairpulling (Trichotillomania): A comparative study of habit reversal and negative practice training

Abstract Hairpulling is an uncommon behavior which has received little study and for which effective treatment has not been established. The present study evaluated the habit reversal and the negative practice method of treatment with 34 subjects randomly assigned to the two treatments. Habit reversal was about twice as effective as the negative practice with respect to the average percentage reduction in hairpulling episodes, the number of subjects who stopped hairpulling entirely, and those who stopped almost entirely. Follow-up phone calls or a single booster session were often effective in preventing or correcting the relapses. It appears that hairpulling can be successfully treated by brief habit reversal training with substantial and enduring benefits.

Dry-bed training: rapid elimination of childhood enuresis.

Abstract Enuresis has been treated with moderate effectiveness by the urine-alarm method which requires many weeks of training. The present procedure used a urine-alarm apparatus but added such features as training in inhibiting urination, positive reinforcement for correct urinations, training in rapid awakening, increased fluid intake, increased social motivation to be nonenuretic, self-correction of accidents, and practice in toileting. After one all-night training session, the 24 enuretic children averaged only two bedwettings before achieving fourteen consecutive dry nights and had no major relapses. Little or no reduction in bedwetting occurred within the first two weeks for matched-control enuretics who were given the standard urine-alarm training. The results of a control-procedure showed that the new procedure did not involve Pavlovian conditioning. The new method appears to be a more rapid, effective and different type of treatment for enuresis.

Dry pants: a rapid method of toilet training children.

Abstract Toilet training sometimes requires considerable time. An intensive learning procedure was devised for shortening this training time and tested with 34 children who were experiencing toilet training problems. The procedure had the following major characteristics: (1) a distraction-free environment, (2) an increased frequency of urination by increased fluid intake, (3) continuous practice and reinforcement of the necessary dressing skills, (4) continuous practice and reinforcement in approaching the toilet, (5) detailed and continuing instruction for each act required in toileting, (6) gradual elimination of the need for reminders to toilet, (7) immediate detection of accidents, (8) a period of required practice in toilet-approach after accidents as well as (9) negative reinforcement for the accident, (10) immediate detection of correct toileting, (11) immediacy of reinforcement for correct toiletings, (12) a multiple reinforcement system including imagined social benefits as well as actual praise, hugging and sweets, (13) continuing reinforcement for having dry pants, (14) learning by imitation, (15) gradual reduction of the need for immediate reinforcement and (16) post-training attention to cleanliness. All 34 children were trained and in an average of 4 hr; children over 26 months old required an average of 2 hr of training. After training, accidents decreased to a near-zero level and remained near zero during 4 months of follow-up. The results suggest that virtually all healthy children who have reached 20 months of age can be toilet trained and within a few hours.

Dry bed: A rapid method of eliminating bedwetting (enuresis) of the retarded☆

Abstract Bedwetting has been a major and unsolved problem for the severely retarded. To solve this problem, an intensive training program was designed similar to a recently developed program for daytime toilet training of the retarded. Some distinctive features of the new procedure were frequent positive reinforcement for correct toileting, a negative reinforcer for accidents, positive practice in night time toileting, increased level of urination by forcing drinking, immediate detection of correct and incorrect toileting, and Positive Practice for accidents. Of twelve retarded adult bedwetters, the average bedwetter required only one night of intensive training. Several days of apparatus monitoring were used following the training but proved unnecessary for two-thirds of the trainees. Accidents were reduced by about 85 % during the first week after training, and almost entirely (95%) during the fifth week with no relapse during a 3 month follow-up. No reduction of accidents resulted when the same bedwetters were given a control procedure that provided no positive or negative reactions other than the sounding of an alarm upon bedwetting. The Dry-Bed procedure appears to be a very rapid solution to the problem of enuresis among the retarded and may be applicable to other difficult populations and also to normals.

Required relaxation: A method of inhibiting agitative-disruptive behavior of retardates.

Abstract Institutionalized retardates frequently exhibit agitative-disruptive behavior. Recent experiments have shown that overcorrective training in specific types of behavior can inhibit inappropriate behavior. A procedure was developed in which overcorrective practice in relaxation was given to each of eight adult retardates for their disruptions. The agitated resident was required to spend a fixed period of time in relaxation in his own bed upon each occurrence of agitation. This overcorrective relaxation resulted in a rapid, enduring and almost complete reduction in such behavior as self-injury, threats, physical aggression, screaming, crying, cursing and tantrums. Ward attendants strongly preferred the required relaxation procedure to the time-out technique and other inhibition procedures they had used. The procedure appears to be about as effective as alternative techniques and to have the advantages of ease of implementation and acceptability by ward staff and retardates as a ‘reasonable’ reaction to agitation.

Sequential effects of punishment.

Punishment is found to produce a large reduction in reinforced responses when it is initially introduced. Continued exposure to punishment, however, results in substantial recovery within each hour of exposure as well as from day to day. A compensatory increase in responding occurs after the removal of punishment, even after the punishment has ceased to be effective.